Method and system for fluorescent imaging with background surgical image composed of selective illumination spectra

ABSTRACT

A surgical site is simultaneously illuminated by less than all the visible color components that make up visible white light, and a fluorescence excitation illumination component by an illuminator in a minimally invasive surgical system. An image capture system acquires an image for each of the visible color components illuminating the surgical site and a fluorescence image, which is excited by the fluorescence excitation component from the illuminator. The minimally invasive surgical system uses the acquired images to generate a background black and white image of the surgical site. The acquired fluorescence image is superimposed on the background black and white image, and is highlighted in a selected color, e.g., green. The background black and white image with the superimposed highlighted fluorescence image is displayed for a user of the system. The highlighted fluorescence image identifies tissue of clinical interest.

RELATED APPLICATION

This application claims priority to and the benefit of:

-   -   U.S. Provisional Application No. 61/361,260 filed Jul. 2, 2010        entitled “METHOD AND SYSTEM FOR FLUORESCENT IMAGING WITH        BACKGROUND SURGICAL IMAGE COMPOSED OF SELECTIVE ILLUMINATION        SPECTRA,” naming as inventors, Ian McDowall and Christopher J.        Hasser, which is incorporated herein by reference in its        entirety.

BACKGROUND

Field of Invention

Aspects of this invention are related to endoscopic imaging, and aremore particularly related to blending visible and alternate images so asto provide an enhanced real-time video display for a surgeon.

Related Art

The da Vinci® Surgical System, commercialized by Intuitive Surgical,Inc., Sunnyvale, Calif., is a minimally invasive teleoperated surgicalsystem that offers patients many benefits, such as reduced trauma to thebody, faster recovery and shorter hospital stay. One key component ofthe da Vinci® Surgical System is a capability to provide two-channel(i.e., left and right) video capture and display of visible images toprovide stereoscopic viewing for the surgeon.

Such electronic stereoscopic imaging systems may output high definitionvideo images to the surgeon, and may allow features such as zoom toprovide a “magnified” view that allows the surgeon to identify specifictissue types and characteristics, as well as to work with increasedprecision. In a typical surgical field, however, certain tissue typesare difficult to identify, or tissue of interest may be at leastpartially obscured by other tissue.

Additional image information of the surgical site may be simultaneouslydisplayed to the surgeon by use of a picture in picture (PIP) display.The additional image information may be useful to the surgeon to improvethe surgical outcome. However, the smaller picture in a PIP display maybe too small to show a desirable level of detailed information. Moreoverwith separate image frames, a surgeon mentally fuses the two separateimages or imaging modalities together, which can be fatiguing.

SUMMARY

In one aspect, a surgical site is simultaneously illuminated by (i) lessthan all the visible color illumination components that make up visiblewhite light, sometimes called white light, and (ii) a fluorescenceexcitation illumination component from an illuminator in a minimallyinvasive surgical system. An image capture system in the minimallyinvasive surgical system acquires an image for each of the visible colorcomponents illuminating the surgical site, and a fluorescence imageexcited by the fluorescence excitation illumination component. Theminimally invasive surgical system uses the acquired image for each ofthe visible color illumination components from the illuminator togenerate a background black and white image of the surgical site. Thisbackground black and white image is referred to as a limited bandwidthimage.

The acquired fluorescence image is superimposed on the background blackand white image and is highlighted in a selected color, e.g., green. Thebackground black and white image with the superimposed highlightedfluorescence image, referred to herein as an augmented display, isdisplayed for a user of the system. The highlighted fluorescence imageidentifies tissue of clinical interest.

The limited bandwidth image with the superimposed highlightedfluorescence image is provided in real time to a surgeon performing asurgical operation using the minimally invasive surgical system. Thisnovel method does not incur the temporal delay necessarily associatedwith capturing a normal image in one frame and the fluorescence image inanother frame and then using the two frames taken at different points intime to generate a single frame that is displayed for the surgeon. Also,the novel method described herein does not result in temporaldeficiencies of either latency or combining two frames acquired atdifferent points in time.

The processing for the augmented display does not introduce any latencyand does not require storage of a frame for subsequent processing with alater frame. Thus, the memory and processing requirements of the systemare reduced with respect to systems that utilize time slicing tosuperimpose a fluorescence image on a stereoscopic visible image.

Also, the highlighted portion of the image is always synchronized withthe background image. In contrast, when a frame including thefluorescence image is stored and then registered to a frame occurringlater in time, the location of the highlighted tissue may have changedbetween the frames and so the highlighted image is displaced from theactual location when displayed. Thus, this novel method is superior fordisplaying moving tissues such as vasculature where methods containingtemporal acquisition mismatches result in displayed motion artifactswhich could be disconcerting to the surgeon.

In one example, a plurality of visible color illumination componentscombine to make white light. An illuminator in the minimally invasivesurgical system simultaneously provides at least two illuminationcomponents. When one of the illumination components is a fluorescenceexcitation illumination component, other illumination componentsprovided by the illuminator include less than all the visible colorillumination components in the plurality of visible color illuminationcomponents.

A camera, in the minimally invasive surgical system, substantiallysimultaneously captures a first acquired component image, and a secondacquired component image that is different from the first acquiredcomponent image. A controller is connected to the camera to receive theacquired component images. Herein, substantially simultaneously meanssimultaneously to the extent that is possible considering temporaldifferences of elements in the camera in responding to a capture triggersignal issued to the camera.

In one aspect, the controller generates first, second, and third visiblecolor components of a limited bandwidth image. Each of these visiblecolor components includes or is derived from the first acquiredcomponent image. The controller adds the second acquired component imageto the second visible color component of the limited bandwidth image sothat the second visible color component includes both the first acquiredcomponent image and the second acquired component image. The limitedbandwidth image does not include an acquired visible color componentimage resulting from at least one of the visible color illuminationcomponents of the plurality of visible color illumination components.

The controller generates an image including the limited bandwidth imagethat is sent to a display connected to the controller. In this aspect,the display receives first, second and third visible color componentsfrom the controller. The display shows an image including the limitedbandwidth image. A portion of the image including the second acquiredcomponent image is highlighted relative to portions of the image notincluding the second acquired component image.

In one aspect, the other illumination components include a first visiblecolor illumination component. The first acquired component image is anacquired first visible color component image while the second acquiredcomponent image is a fluorescence image excited by the fluorescenceexcitation illumination component.

In another aspect, the other illumination components include the firstvisible color illumination component and a second visible colorillumination component. In this aspect, the camera also captures a thirdacquired component image. The first acquired component image is anacquired first visible color component image. The second acquiredcomponent image is the acquired fluorescence image. The third acquiredcomponent image is an acquired second visible color component image. Thecontroller generates the first, second, and third color components ofthe limited bandwidth image from the acquired first and second visiblecolor component images. In one example, the first visible colorcomponent is a blue color component, and the second visible colorcomponent is a green color component.

In yet another aspect, the other illumination components are a firstvisible illumination component and a second fluorescence excitationillumination component. Again, in this aspect, the camera captures athird acquired component image. The first acquired component is theacquired first visible color component image. The second acquiredcomponent image is the acquired first fluorescence image. The thirdacquired component image is an acquired second fluorescence image. Thecontroller adds the third acquired image to the third visible colorcomponent of the limited bandwidth image.

In one aspect, the illuminator includes a first visible colorillumination component source, a second visible color illuminationcomponent source where the second visible color illumination componentis different from the first visible color illumination component, and athird visible color illumination component source, where the thirdvisible color illumination component is different from the secondvisible color illumination component, and different from the firstvisible color illumination component. The illuminator also includes afluorescence excitation illumination source.

The minimally invasive surgical system also includes a power level andpower supply controller connected to the first, second, and thirdvisible color component illumination sources, and to the fluorescenceexcitation illumination source. A mode changer is coupled to the powerlevel and power supply controller. The mode changer has a first stateand a second state.

When the mode changer has the first state, the power level and powersupply controller (a) provides power to the first, second, and thirdvisible color illumination component sources, and not to thefluorescence excitation source, and (b) the first, second, and thirdvisible color illumination component sources have a first level ofillumination. When the mode changer has the second state, the powerlevel and power supply controller (a) provides power to the firstvisible color illumination component source, to at least a portion ofthe second visible color illumination component source and to thefluorescence excitation source, and not to the third visible colorillumination component source, and (b) reduces the levels ofillumination of the first visible color illumination component sourceand the second visible color illumination component source.

In a method of generating an augmented image display in a minimallyinvasive surgical system, a controller generates a first visible colorcomponent of a limited bandwidth image including a first acquiredcomponent image. The controller also generates a second visible colorcomponent of the limited bandwidth image including the first acquiredcomponent image. The controller adds a second acquired component imageto the second visible color component. The second acquired componentrepresents fluorescence excited by illumination from a firstfluorescence excitation illumination source. The controller generates athird visible color component of the limited bandwidth image includingthe first acquired component image. The limited bandwidth image does notinclude an acquired visible color component image resulting from onevisible color illumination component in the plurality of visible colorillumination components of white light.

The method displays on a display screen, an image including the limitedbandwidth image. A portion of the image including the second acquiredcomponent image is highlighted relative to portions of the image notincluding the second acquired component image.

In another aspect of a method of generating an augmented image displayin a minimally invasive surgical system, an augmented image correctionmodule is executed on a processor. The execution generates a method thatreceives, on a first visible color component input of a plurality ofvisible color component inputs, an acquired first visible colorcomponent image. The method also receives, on a second visible colorcomponent input of the plurality of visible color component inputs, anacquired fluorescence image.

The method generates, on a first visible color component output, a firstsignal including the acquired first visible color component image. On asecond visible color component output, a second signal including acombination of the acquired first visible color component image and theacquired fluorescence image is generated. Also, on a third visible colorcomponent output, a third signal including the acquired first visiblecolor component image is generated. A combination of the first, secondand third signals is an image including a limited bandwidth image andthe fluorescence image.

This method also receives, on a third visible color component input ofthe plurality of visible color component inputs, an acquired secondvisible color component image. In this aspect, the first and thirdsignals include a combination of the acquired first visible colorcomponent image and the acquired second visible color component image.The second signal includes the acquired fluorescence image plus thecombination of the acquired first visible color component image and theacquired second visible color component image.

In a different aspect, the method receives, on a third visible colorcomponent input of the plurality of visible color component inputs, anacquired second fluorescence image. In this aspect, the third signal isa combination of the acquired first visible color component image andthe acquired second fluorescence image.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a high level diagrammatic view of a minimally invasiveteleoperated surgical system including an augmented stereoscopicvisualization system.

FIG. 2 is a schematic view that illustrates hardware and software (imageprocessing and user interface) aspects of augmented stereoscopicvisualization system.

FIG. 3 is process flow diagram of a process performed using, forexample, the augmented stereoscopic visualization system of theminimally invasive teleoperate surgical system of FIG. 1.

FIG. 4 illustrates one aspect of the timing, synchronization, andcapture in the system in FIGS. 2 and 3.

FIG. 5A is a representation of a normal color stereoscopic imageobtained using the system of FIG. 2.

FIG. 5B is a representation of a limited bandwidth stereoscopic imageobtained using the system of FIG. 2 with a highlighted superimposedfluorescence image.

FIG. 6 is a block diagram of one aspect of the augmented imagecorrection process of FIG. 2.

FIG. 7 illustrates another aspect of the timing, synchronization, andcapture in the system in FIGS. 2 and 3.

FIG. 8 is a block diagram of another aspect of the augmented imagecorrection process of FIG. 2.

In the drawings, the first digit of a reference number indicates thefigure in which the element with that reference number first appeared.

DETAILED DESCRIPTION

As used herein, electronic stereoscopic imaging includes the use of twoimaging channels (i.e., channels for left and right images).

As used herein, a stereoscopic optical path includes two channels in anendoscope for transporting light from tissue (e.g., channels for leftand right images). The light transported in each channel represents adifferent view of the tissue. The light can include one or more images.Without loss of generality or applicability, the aspects described morecompletely below also could be used in the context of a field sequentialstereo acquisition system and/or a field sequential display system.

As used herein, an illumination path includes a path in an endoscopeproviding illumination to tissue.

As used herein, images captured in the visible electromagnetic radiationspectrum are referred to as acquired visible images.

As used herein, white light is visible white light that is made up ofthree (or more) visible color components, e.g., a red visible colorcomponent, a green visible color component, and a blue visible colorcomponent. Thus, white light has a plurality of visible colorcomponents. If the visible color components are provided by anilluminator, the visible color components are referred to as visiblecolor illumination components. White light may also refer to a morecontinuous spectrum in the visible spectrum as one might see from aheated tungsten filament, for example.

As used herein, a black and white image that is generated using anilluminator that provides less than all of a plurality of visible colorilluminations components of white light is referred to as a limitedbandwidth image.

As used herein, images captured as the result of fluorescence arereferred to herein as acquired fluorescence images. There are variousfluorescence imaging modalities. Fluorescence may result from the useof, for example, injectable dyes, fluorescent proteins, or fluorescenttagged antibodies. Fluorescence may result from, for example, excitationby laser or other energy source. Fluorescence images can provide vitalin vivo patient information that is critical for surgery, such aspathology information (e.g., fluorescing tumors) or anatomic information(e.g., fluorescing tagged tendons).

Aspects of this invention augment the stereoscopic video capturing andviewing capability of a minimally invasive surgical system, e.g., the daVinci® minimally invasive teleoperated surgical system commercialized byIntuitive Surgical, Inc. of Sunnyvale, Calif., by incorporating bothstereoscopic normal visible images, and alternatively stereoscopiclimited bandwidth visible images having superimposed thereonfluorescence images. (da Vinci® is a registered trademark of IntuitiveSurgical, Inc. of Sunnyvale, Calif.) A stereoscopic limited bandwidthvisible image with a superimposed highlighted fluorescence imageprovides a stereoscopic image of a surgical site with pathologyinformation and/or anatomic information highlighted for the surgeon. Thehighlighted fluorescence image identifies tissue of clinical interest.

The stereoscopic limited bandwidth image with the superimposedhighlighted fluorescence image is provided in real time to a surgeonperforming a surgical operation using a minimally invasive teleoperatedsurgical system. Sequential acquisition approaches (also known as timeslicing) incur a delay associated with capturing a stereoscopic image inone frame and the fluorescence image in another frame and then using thetwo frames taken at different points in time to generate a single framethat is displayed for the surgeon. Hence, the memory and processingrequirements of the system described herein are reduced with respect tosystems that utilize time slicing to superimpose a fluorescence image ona stereoscopic color visible image.

The stereoscopic limited bandwidth visible image is formed using lessthan all the plurality of visible color illumination components thatmake white light and so color information in the limited bandwidthvisible image is lost but there is little or no loss in detail. Thestereoscopic limited bandwidth visible image is sufficient to identifyanatomy, tissue landmarks, and surgical instruments so that this imageallows safe manipulation of the surgical instruments. With the limitedbandwidth visible image, there is no loss in contrast of thefluorescence image due to interference by a visible color illuminationcomponent.

The fluorescence image is overlaid onto the limited bandwidth visibleimage and color enhanced to provide improved information contentregarding the surgical site that reduces the risk of injury to thepatient and that improves surgical efficiency. This combination of astereoscopic limited bandwidth visible image and a highlightedfluorescence image provides benefits including, but not limited to,allowing a surgeon in real-time to identify positive tumor margins fordiseased tissue excision and to identify other tissue, e.g., tendons, soas to avoid unnecessarily cutting that tissue.

The combination of the stereoscopic limited bandwidth images andfluorescence images may be continuously displayed to the surgeon.Alternatively, the overlay of the two images may be toggled on and off(e.g., by using a foot pedal or by double-clicking master finger gripson the da Vinci® Surgical System surgeon's console).

FIG. 1 is a high level diagrammatic view of a minimally-invasiveteleoperated surgical system 100, for example, the da Vinci® SurgicalSystem, including an augmented stereoscopic visualization system. Inthis example, a surgeon, using a surgeon's console 114, remotelymanipulates an endoscope 112 mounted on a robotic manipulator arm 113.There are other parts, cables etc. associated with the da Vinci®Surgical System, but these are not illustrated in FIG. 1 to avoiddetracting from the disclosure. Further information regarding minimallyinvasive surgical systems may be found for example in U.S. patentapplication Ser. No. 11/762,165 (filed Jun. 13, 2007; disclosingMinimally Invasive Surgical System) and U.S. Pat. No. 6,331,181 (filedDec. 18, 2001; disclosing Surgical Robotic Tools, Data Architecture, andUse), both of which are incorporated herein by reference.

As explained more completely below, an illumination system (not shown),sometimes referred to as an illuminator, is coupled to endoscope 112.The illumination system selectively provides one of (a) white lightillumination and (b) less than all the visible color illuminationcomponents of white light and at least one fluorescence excitationillumination component. The light from the illumination system iscoupled to at least one illumination path in endoscope 112 by a fiberoptic bundle (See fiber optic bundle 216 in FIG. 2). The light passesthrough at least one illumination path in endoscope 112 and illuminatestissue 103 of a patient 111.

Endoscope 112 also includes, in one aspect, two optical channels forpassing light from the tissue, e.g., reflected white light or thereflected light from the visible color illumination component(s) andfluorescence. The reflected white light is used to form a normal visibleimage or images. As explained more completely below, the reflected lightfrom the visible color illumination component(s) is used to form thelimited bandwidth visible image.

The white light reflected from tissue 103 is captured as normal acquiredvisible color stereoscopic images in image capture system 120 when theillumination source is providing white light illumination. However, whenthe surgeon wants to see an augmented image, the surgeon changes theviewing mode to an augmented viewing mode.

In the augmented viewing mode, at least one of the plurality of visiblecolor illumination components of white light is turned off so that theillumination source provides less than all of the visible colorillumination components of white light. For example, if three visiblecolor illumination components of white light are used, at most twovisible color illumination components are provided by the illuminationsource. Thus, in this aspect of the augmented viewing mode, tissue 103is illuminated with one or two visible color illumination components,e.g., with less than all the plurality of visible color illuminationcomponents of white light, and a fluorescence excitation illuminationcomponent.

In the augmented viewing mode, acquired left and right visible colorcomponent images are captured by element 121 for each visible colorcomponent provided by the illuminator and the fluorescence is capturedby element 122 as left and right fluorescence images. Image capturesystem 120 is a conventional image capture system except any filter orfilters that would block the fluorescence are removed, and a filter orfilters may be used to block capture of any direct light or reflectedlight from the fluorescence excitation source or sources.

Display image controller 130 receives the acquired information fromimage capture system 120. When the acquired information is the normalvisible color stereoscopic images, display image controller 130processes the normal acquired visible color stereoscopic imagesincluding color correcting the acquired images and sends the colorcorrected acquired visible color stereoscopic images to the viewer onsurgeon's console 114, which displays the images.

Similarly, in the augmented viewing mode, display image controller 130receives the acquired information from image capture system 120, i.e.,an acquired visible stereo color component image for each visible colorcomponent provided by the illumination source and the acquired left andright fluorescence images. In the augmented viewing mode, display imagecontroller 130 uses an augmented image correction process in place ofthe normal color correction process.

The augmented image correction process uses the acquired visible stereocolor component(s) images to generate the limited bandwidth image. Forexample if the illumination source provides two visible colorillumination components, i.e., a first visible color illuminationcomponent and a second visible color illumination component, theacquired visible color component images are a combination of an acquiredfirst visible color component image and an acquired second visible colorcomponent image.

The augmented image correction process in display image controller 130combines the acquired first and second visible color component imagesand provides the combination to each of the color component inputs ofthe display on surgeon's console 114. The display generates the limitedbandwidth image. The image is a limited bandwidth image because theimage does not include an acquired visible color component image for athird visible color illumination component.

In addition, the augmented image correction process adds the acquiredfluorescence image to one of the color component inputs of the displayso that one of the color component inputs receives the fluorescenceimage plus the combination of the acquired first and second visiblecolor component images. The other two color component inputs to thedisplay receive only the combination of the acquired first and secondvisible color component images. If the fluorescence image is added tothe green component, in this example, the surgeon sees a stereoscopicblack and white like image of the surgical site with the tissue or otheranatomical feature that generated the fluorescence highlighted in green.

Referring now to FIGS. 2 to 4 together, FIG. 2 is a more detailedillustration of the aspects of one example of minimally invasivesurgical system 100 of FIG. 1. FIG. 3 is a process flow diagram for theoperation of the system in FIG. 2, while FIG. 4 is a timing diagram forthe illumination of tissue and the capture of images in the system ofFIG. 2.

In the embodiment of FIG. 2, minimally invasive surgical system 200includes an illuminator that is combination light source 210.Combination light source 210 includes a visible color component source211 and a fluorescence excitation source 212. The particularimplementation of sources 211 and 212 is not critical so long ascombination light source 210 has the capabilities described morecompletely below.

Combination light source 210 is used in conjunction with at least oneillumination path in a stereoscopic endoscope 201 to illuminate tissue203 in an ILLUMINATE TISSUE process 302 (FIG. 3). In this example,combination light source 210 has two modes of operation: a normalviewing mode and an augmented viewing mode.

In the normal viewing mode, visible color component source 211 providesillumination that illuminates tissue 203 in white light, i.e., all thevisible color illumination component sources in source 211 are used.Fluorescence excitation source 212 is not used in the normal viewingmode.

In the augmented viewing mode, visible color component source 211provides less than all the visible color components needed to illuminatetissue 203 in white light, e.g., one or more of the visible colorcomponents of white light are not included in the illumination. In someaspects, for example, it may be possible to use all the visible colorillumination components of white light in the augmented viewing mode,but include trivial illumination from one or more of the visible colorillumination component sources and augmented viewing mode illuminationfrom the remaining visible color component illumination sources. Trivialillumination means that the illumination provided by the visible colorillumination component source is so low that when a trivial illuminationimage and florescence are acquired together as a common acquired image,the acquired trivial illumination image does not degrade the acquiredfluorescence image. Thus, providing trivial illumination for the one ormore visible color illumination components is effectively the same asilluminating the tissue with less than all the visible color componentsof white light.

In one aspect, three visible color components make up white lightillumination, i.e., white light includes a first visible colorcomponent, a second visible color component, and a third visible colorcomponent. Each of the three visible color components is a differentvisible color component, e.g., a red component, a green component and ablue component. The use of three visible color components to make upwhite light illumination is illustrative of a plurality of suchcomponents and is not intended to be limiting.

In the augmented viewing mode, fluorescence excitation source 212provides a fluorescence excitation illumination component that excitesfluorescence from tissue 203. For example, narrow band light fromfluorescence excitation source 212 is used to excite tissue-specificfluorophores so that fluorescence images of specific tissue withintissue 203 are captured.

In the augmented viewing mode, the number of visible color illuminationcomponents provided by visible color component source 211 depends on thenumber of different fluorescence images captured. If one fluorescenceimage is captured, one or two different visible color illuminationcomponents are provided by visible color component source 211 in thisexample. If two different fluorescence images are captured, one visiblecolor illumination component is provided by visible color componentsource 211.

In one aspect, visible color component source 211 includes a source foreach of the different visible color illumination components in theplurality of visible color illumination components of white light. For ared-green-blue implementation, in one example, the sources are lightemitting diodes (LEDs), a red LED, two green LEDs and a blue LED. Table1 gives the range of output wavelengths for each of the LEDs used inthis example.

TABLE 1 Visible Color Illumination Component Wavelength Red 670nanometers (nm) Green 1 555 nm Green 2 532 nm Blue 450 nm

The use of LEDs in visible color component source 211 is illustrativeonly and is not intended to be limiting. Visible color component source211 could also be implemented with multiple laser sources instead ofLEDs for example. Alternatively, visible color component source 211could use a Xenon lamp with an elliptic back reflector and a band passfilter coating to create broadband white illumination light for visibleimages. The use of a Xenon lamp also is illustrative only and is notintended to be limiting. For example, a high pressure mercury arc lamp,other arc lamps, or other broadband light sources may be used. Toeliminate one or more visible color illumination components from such asource in the augmented viewing mode, bandpass filters, prisms etc.could be incorporated in combination light source 210.

Also, in the augmented viewing mode if the fluorescence excitationwavelength occurs in the visible spectrum, visible color componentsource 211 (FIG. 3B) may be used as both the source of the visible colorillumination components and the source of the fluorescence excitationillumination component. If the fluorescence excitation wavelength occursoutside the visible spectrum (e.g., in the near infrared (NIR)), a lasermodule (or other energy source, such as a light-emitting diode orfiltered white light) is used as fluorescence excitation source 212.

Thus, in one aspect, fluorescence is triggered by light from a lasermodule in fluorescence excitation source 212. As an example, antibodyagents, which were obtained from Medarex, Inc., were excited using a 525nm laser.

The particular fluorescence excitation source selected for combinationlight source 210 depends on the fluorophore or fluorophores used.Excitation and emission maxima of various FDA approved fluorescent dyesused in vivo are presented in Table 2.

TABLE 2 Excitation Emission Fluorescent Dye maxima (nm) maxima (nm)Fluorscein 494 521 Indocyanine 810 830 Green Indigo Carmine 436 inalkaline 528 in alkaline solution solution Methylene Blue 664 682

Table 3 presents examples of common protein fluorophores used inbiological systems.

TABLE 3 Fluorescent proteins/ Excitation Emission Fluorophore maxima(nm) maxima (nm) GFP 489  508  YFP 514  527  DsRed (RFP) 558  583  FITC494** 518** Texas red 595** 615** Cy5 650** 670** Alexa Fluor 568 578**603** Alexa Fluor 647 650** 668** Hoechst 33258 346  460  TOPRO-3 642 661  **Approximate excitation and fluorescence emission maxima forconjugates.

Those knowledgeable in the field understand that a fluorophore can bebound to an agent that in turn binds to a particular tissue of thepatient. When a particular fluorophore is selected, combination lightsource 210 includes fluorescence excitation source 212 that provideslight with the excitation maxima wavelength for that fluorophore. Thus,given the fluorophore or fluorophores of interest and the number ofdifferent fluorophores used, appropriate light sources can be includedin combination light source 210.

The above examples in Tables 2 and 3 are illustrative only and are notintended to limit this aspect to the particular examples presented. Inview of this disclosure, an alternate imaging characteristic of thetissue can be selected and then an appropriate light source can beselected based upon the fluorescence being utilized.

In either the normal or augmented viewing modes, the light from thelight source or light sources is directed into a fiber optic bundle 216.Fiber optic bundle 216 provides the light to an illumination path instereoscopic endoscope 201 that in turn directs the light to tissue 203.

The video output on stereoscopic display 241 may be toggled between thenormal and augmented viewing modes by using, e.g., a foot switch, adouble click of the master grips that control the surgical instruments,voice control, and other like switching methods. The toggle forswitching between the two viewing modes is represented in FIG. 2 asdisplay mode select 250.

In response to a user input from display mode select 250, a signal isprovided to a VIEWING MODE check process 301 (FIG. 3) in a userinterface 260 that in turn provides a control signal to an ILLUMINATETISSUE process 302 when the normal viewing mode is selected. Userinterface 260, in one aspect, is generated by computer code, which isstored in a memory 132, executing on a processor 131 (FIG. 1).

In one aspect, the normal viewing mode is a default mode. In thisaspect, display mode select 250 would not be used until the surgeonwanted to change the viewing mode from the normal viewing mode to theaugmented viewing mode, or from the augmented viewing mode to the normalviewing mode.

In the normal viewing mode, ILLUMINATE TISSUE process 302 sends a normalviewing mode operation signal to power and level controller 215 incombination light source 210. Power and level controller 215 isillustrated in combination light source 210 for convenience and is notintended to limit the location of power and level controller 215 to thisspecific location.

In response to the normal viewing mode operation signal, power and levelcontroller 215 turns off fluorescence excitation source 212, if source212 is on, and enables visible color component source 211 so that whitelight is provided to tissue 203. For example, when visible colorcomponent source 211 includes three visible color illumination componentsources, power is provided to each of the three sources. Thoseknowledgeable in the field recognize that instead of turning the poweron and off to the various sources in 210, controller 215 could maintainthe power always on and direct the output from the sources to and awayfrom fiber optic bundle 216 and achieve the same result.

Thus, in the normal viewing mode, ILLUMINATE TISSUE process 302 causestissue 203 to be illuminated with white light. In the graphs of theillumination in FIG. 4, the horizontal axis is time and the verticalaxis represents source output level. The source output level duringnormal viewing mode operation for each of the three visible colorillumination components is defined as 100 percent. Thus, in FIG. 4 fortimes before time t1, the output level from each of the three visiblecolor illumination components is shown as 100 percent and the outputlevel for the fluorescence excitation illumination component is zero.

The visible light from tissue 203 (FIG. 2) is passed by the stereoscopicoptical path in endoscope 202 to image capture system 220. Image capturesystem 220, in this aspect, includes a conventional stereoscopic camerathat includes a left image charge coupled device (CCD) 221A and a rightimage CCD 222A.

Thus, in CAPTURE IMAGES process 303 (FIG. 3) in the normal viewing mode,left image CCD 221A captures a visible left image 421A (FIG. 4) andright image CCD 222A captures a visible right image 422A. Left image CCD221A captures red, green, and blue images for visible left image 421A,i.e., the acquired left image is a color image. Similarly, right imageCCD 222A captures red, green, and blue images for visible right image422A.

Left image CCD 221A and right image CCD 222A can be multiple CCDs thateach capture a different visible color component; a single CCD withdifferent regions of the CCD that capture a particular visible colorcomponent, etc. A three-chip CCD sensor is illustrative only. A singleCMOS image sensor with a color filter array or a three-CMOS color imagesensor assembly may also be used.

In the normal viewing mode, acquired normal visible left visible image421A and acquired normal visible right image 422A (FIG. 4) are providedto display image controller 230 (FIG. 2) that performs IMAGE PROCESSINGprocess 304 (FIG. 3). In IMAGE PROCESSING process 304, a COLOR IMAGECORRECTION process 231 processes both acquired normal visible leftvisible image 421A and acquired normal visible right image 422A. Thecolor corrected acquired normal visible left visible image and the colorcorrect acquired normal visible right image are sent to stereoscopicdisplay 241 and a stereoscopic color image is displayed in GENERATE ASTEREOSCOPIC VIDEO DISPLAY OF TISSUE process 305.

The processing in the normal viewing mode is equivalent to theprocessing in a conventional minimally-invasive surgical system and sois known to those knowledgeable in the field. Also, processes 301 to 305are performed repetitively for each frame so that the surgeon sees areal-time video image of tissue 203.

During the normal viewing mode, the surgeon is provided with a normalthree-dimensional color view 500A of tissue 203A (FIG. 5A). However, thesurgeon may wish to see a region or regions of interest in tissue 203Ahighlighted in the three-dimensional view of tissue 203A. For example,the surgeon may which to see diseased portions of tissue 203A and/or aspecific tissue, e.g., a tendon or organ. Thus, at time t1 (FIG. 4), thesurgeon uses display mode select 250 to change the viewing mode to theaugmented viewing mode.

In response to the user input from display mode select 250, an augmenteddisplay selection signal is provided to a VIEWING MODE check process 301in user interface 260. In response to the augmented display selectionsignal, check process 301 provides an augmented imaging control signalto ILLUMINATE TISSUE process 302 and to IMAGE PROCESSING process 304.

In response to the augmented display control signal, ILLUMINATE TISSUEprocess 302 sends an augmented display signal to power and levelcontroller 215 in combination light source 210. In response to theaugmented display signal, power and level controller 215 turns onfluorescence excitation source 212 and in this example turns off thethird visual color illumination component in visible color componentsource 211 so that only first and second visual color illuminationcomponents and the fluorescence excitation illumination component aresupplied to fiber optic bundle 216.

Thus, tissue 203 is illuminated with the first and second visual colorillumination components, but not with the third visual colorillumination component. Tissue 203 is also illuminated with thefluorescence excitation illumination component 212.

Also, in one embodiment, power and level controller 215 reduces theoutput level of the first and second visual color illuminationcomponents, e.g., reduces the output level to one part in ten. Thus, asshown in FIG. 4, after time t1, the output level of the first and secondvisual color illumination components is reduced relative to the outputlevel prior to time t1, and the third visual color componentillumination output level is zero. Also, the fluorescence excitationillumination component is turned on.

In this example, the fluorescence excited by fluorescence excitationillumination component is captured by the CCD or the part of the CCD forthe third visual color component. For example, if the fluorescence is inthe near infrared, the third visual color component is the red colorcomponent and the first and second visual color components are the blueand green color components.

Alternatively, if the fluorescence were in the range of the greenvisible color component, the third visible color illumination componentwould be the green visible color component and would be turned off insource 211, and the first and second visual color components are the redand blue color components. If the fluorescence were in the ultravioletrange, the third visible color illumination component would be the bluecolor component and would be turned off in source 211, and the first andsecond visual color components are the red and green color components.

As used herein, “first,” “second,” and “third” are adjectives used todistinguish between visible color components. Thus, “first,” “second,”and “third” are not intended to imply any ordering of the visible colorcomponents within the visible wavelength spectrum.

In one aspect to assure that there is no incident light on tissue 203 inor near the wavelengths for the visible color illumination componentturned off, wavelengths of the adjacent color visible color illuminationcomponent(s) that are near or overlap with the wavelengths of theturned-off visible color illumination component are in some way blocked.This assures that the acquired fluorescence image is not degraded by anyvisible light captured by the CCD that captures the fluorescence image.For example, when visible color component source 211 has the foursources given in Table 1, and the third visible color illuminationcomponent is the red visible color component, the green source withwavelengths adjacent to the wavelengths of the red source is also turnedoff in the augmented viewing mode.

The light from tissue 203 (FIG. 2) are passed by the stereoscopicoptical path in endoscope 202 to image capture system 220. In oneaspect, filters 221B 222B are used to filter any reflected or directlight from fluorescence excitation source 212 before the images arecaptured.

In CAPTURE IMAGES process 303 (FIG. 3), in the augmented viewing mode,left image CCD 221A captures acquired left first and second visiblecolor component images and an acquired left fluorescence image 421B(FIG. 4) and right image CCD 222A captures acquired right first andsecond visible color component images and an acquired right fluorescenceimage 422B. For example, if the third visible color component is the redvisible color component, the blue and green CCDs in left image CCD 221Acapture respectively blue and green left visible color component imagesfor the left image. The red CCD in left image CCD 221A captures the leftfluorescence image. Similarly, the blue and green CCDs in right imageCCD 222A capture respectively blue and green visible color componentimages for the right image. The red CCD in right image CCD 222A capturesthe right fluorescence image.

In this example, there is not a third visible color componentillumination source, and consequently there is no third visible colorcomponent light reflected from tissue 203. This leaves the CCD orportion of the CCD, which normally captures the third visible colorcomponent light in the images, available to capture the fluorescenceimage. Thus, no additional cameras, optic paths in the endoscope, oradditional endoscopes are needed to acquire both the visible colorcomponent images and the fluorescence image. Herein, when it is statedthat a visible color component image in an image is associated with avisible color component illumination source, it means that the visiblecolor component illumination source provides the light that results inthat visible color component image in the image.

In the augmented viewing mode, the acquired left first and secondvisible color component images and the acquired left fluorescence imagealong with the acquired right first and second visible color componentimages and the acquired right fluorescence image are provided to displayimage controller 230 that performs IMAGE PROCESSING process 304. Recall,as described above, IMAGE PROCESSING process 304 has received theaugmented display signal. Thus, IMAGE PROCESSING process 304 changesfrom COLOR IMAGE CORRECTION process 231 to AUGMENTED IMAGE CORRECTIONprocess 232.

AUGMENTED IMAGE CORRECTION process 232 performs the same process on boththe left and right images, and so the left and right designation is notconsidered in the description. FIG. 6 is a block diagram of the inputinformation to AUGMENTED IMAGE CORRECTION process 232A, and the outputinformation from AUGMENTED IMAGE CORRECTION process 232A for thisexample.

AUGMENTED IMAGE CORRECTION process 232A receives on a first colorcomponent input, acquired first visible color component image AVC1; onsecond color component input, acquired second visible color componentimage AVC2; and on a third color component input, acquired fluorescenceimage AF. AUGMENTED IMAGE CORRECTION process 232A combines acquiredfirst visible color component image AVC1 and acquired second visiblecolor component image AVC2, e.g., forms the average of the two acquiredcomponent images for generation of the limited bandwidth visible image.Each color component of the limited bandwidth image is the average ofthe two acquired visible color component images.

AUGMENTED IMAGE CORRECTION PROCESS 232, in this example, adds acquiredfluorescence image AF to second visible color component of theband-width limited image, which is the combination of acquired firstvisible color component image AVC1 and acquired second visible colorcomponent image AVC2. The result of the addition is supplied to thesecond visible color component output. In this example, the secondvisible color component output is the output for the visible colorcomponent that empirical studies show to be preferred by surgeons, e.g.,the green color component.

In this example, the combination of the acquired first visible colorcomponent image AVC1 and acquired second visible color component imageAVC2 is sent to each of the first and third visible color componentoutputs. Acquired fluorescence image AF plus the combination of theacquired first visible color component image AVC1 and acquired secondvisible color component image AVC2 is sent to the second visible colorcomponent output. Those knowledgeable in the field understand that theoperations described with respect to AUGMENTED IMAGE CORRECTION process232 are done with respect to a subunit of a frame, e.g., on a pixel bypixel basis and that the “addition” is symbolic and may require undoingand redoing gamma correction for example to achieve a clear image.

The outputs from AUGMENTED IMAGE CORRECTION process 232 are displayed onstereoscopic display 241 (FIG. 2) in GENERATE STEREOSCOPIC VIDEO DISPLAYOF TISSUE process 305 (FIG. 3). In the augmented viewing mode, processes301 to 305 are performed repetitively so that the surgeon sees areal-time video augmented image of tissue 203.

During the augmented viewing mode, the surgeon is provided with athree-dimensional limited-bandwidth image of tissue 203 with region ofinterest 503 (FIG. 5B) highlighted in a particular color. In thisexample where two visible color component illumination sources wereused, the limited-bandwidth image of tissue 203 is a monochrome limitedbandwidth image.

While image 203A in FIG. 5A is in full color and image 203B is a limitedbandwidth monochromatic image, the level of detail and information inthe two images is equivalent, but unit image 203B includes additionalhighlighted information 503. The switch between the viewing modes forimages 203A and 203B is fast and occurs in real time.

The processing for the augmented display does not introduce any latencyand does not require storage of a frame for subsequent processing with alater frame. The processing occurs in real time and so the highlightedportion of the three-dimensional image is always synchronized with thelimited-bandwidth monochromatic portion of the three-dimensional image.In contrast, when a frame including the fluorescence image is stored andthen registered to a frame occurring later in time, the location of thehighlighted tissue may have changed and so the highlighted image isdisplaced from the actual location when displayed.

When the surgeon wants to change the viewing mode back to the normalstereoscopic color image at time t2 (FIG. 4), the surgeon uses displaymode select 250 (FIG. 2) to change the viewing mode to the normalviewing mode. In response to the change, fluorescence excitation source212 is turned off; the third visible color illumination component isturned on; and the first and second visible color illuminationcomponents are returned to the full output level. See FIG. 4. Theprocessing is the same as that described above for the normal viewingmode and so is not repeated.

In one aspect, IMAGE PROCESSING process 304 (FIG. 3) is performed byexecuting an image correction module 135 (FIG. 1), which is stored inmemory 132, on a processor 131. In this example, image correction module135 includes a color module 136 and an augmented module 137. When colormodule 136 is executed on processor 131, COLOR IMAGE CORRECTION process231 is performed. When augmented module 137 is executed on processor131, AUGMENTED IMAGE CORRECTION process 232 is performed. The use of twomodules 136, 137 is illustrative. Those knowledge in the art understandthat the two modules could be implemented as a single module, forexample.

Although, process 304 is described herein as including executing amodule on a processor, it is to be appreciated that process 304 withprocesses 231 and 232 may be implemented in practice by any combinationof hardware, software that is executed on a processor, and firmware.Also, the functions, as described herein, may be performed by one unit,or divided up among different components, each of which may beimplemented in turn by any combination of hardware, software that isexecuted on a processor, and firmware. When divided up among differentcomponents, the components may be centralized in one location ordistributed across system 100 for distributed processing purposes.

The above example is illustrative only and is not intended to belimiting. In the augmented viewing mode, various combinations offluorescence excitation sources and visible color component illuminationsources can be used. For example, a surgeon may want to see bothdiseased tissue, e.g., a fluorescing tumor, and other specific tissue,e.g., a fluorescing tagged tendon, so as to avoid cutting the tissue.Thus, two different fluorophores are used that require two differentfluorescence excitation sources (See FIG. 7) in fluorescence excitationsource 212 (FIG. 2).

In response to the augmented display control signal at time t3,ILLUMINATE TISSUE process 302 sends an augmented display signal to powerand level controller 215 in combination light source 210. In response tothe augmented display signal, power and level controller 215 turns onthe two fluorescence excitation illumination components in fluorescenceexcitation source 212 and in this example turns off the second and thirdvisual color illumination components in visible color component source211 so that only first visual color illumination component, the firstfluorescence excitation illumination component and the secondfluorescence excitation illumination component are supplied to fiberoptic bundle 216.

Tissue 203 is illuminated with the first visual color illuminationcomponent, but not with the second and third visual color illuminationcomponents. Tissue 203 is also illuminated with first and secondfluorescence excitation illumination components.

Also, in one embodiment, power and level controller 215 reduces theoutput level of the first visual color illumination component, e.g.,reduces the output level to one part in ten. Thus, as shown in FIG. 7,after time t3, the output level of the first visual color illuminationcomponent is reduced relative to the output level prior to time t3, andthe second and third visual color illumination component output levelsare zero. Also, the first and second fluorescence excitationillumination components are turned on.

The light from tissue 203 (FIG. 2) is passed by the stereoscopic opticalpath in endoscope 202 to image capture system 220. In one aspect,filters 221B 222B are used to filter any reflected or direct light fromthe two fluorescence excitation illumination components fromfluorescence excitation source 212 before the fluorescence images arecaptured.

Thus, in CAPTURE IMAGES process 303 (FIG. 3) in the augmented viewingmode, left image CCD 221A captures an acquired left first visible colorcomponent image, an acquired left first fluorescence image, and anacquired left second fluorescence image 721B (FIG. 7). Right image CCD222A captures an acquired right first visible color component image, anacquired right first fluorescence image, and an acquired right secondfluorescence image 722B (FIG. 7).

For example, if the third visible color component is the red visiblecolor component and the second visible color component is blue, thegreen CCD in left image CCD 221A captures the green left visible colorcomponent image for the left image. The red CCD in left image CCD 221Acaptures the left second fluorescence image and the blue CCD in leftimage CCD 221 captures the left first fluorescence image. Similarly, thegreen CCD in right image CCD 222A captures the green visible colorcomponent images for the right image. The red CCD in right image CCD222A captures the right second fluorescence image and the blue CCD inright image CCD 222A captures the right first fluorescence image.

In this example, there is neither a second visible color componentillumination source nor a third visible color component illuminationsource. Consequently, light associated with the second and third visiblecolor illumination components is not included in the light from tissue203. This leaves the CCDs or portions of the CCD, which normally capturethe second and third visible color components' light in the images,available to capture the fluorescence images.

Recall, as described above, IMAGE PROCESSING process 304 has receivedthe augmented display signal. Thus, IMAGE PROCESSING process 304 changesfrom COLOR IMAGE CORRECTION process 231 for images 721B, 722B toAUGMENTED IMAGE CORRECTION process 232.

Again, AUGMENTED IMAGE CORRECTION process 232 performs the same processon both the left and right images, and so the left and right designationis not considered in the description. FIG. 8 is a block diagram of theinput information to AUGMENTED IMAGE CORRECTION process 232B, and theoutput information from AUGMENTED IMAGE CORRECTION process 232B.

AUGMENTED IMAGE CORRECTION process 232B receives on a first colorcomponent input, acquired first visible color component image AVC1; onsecond color component input, acquired first fluorescence image AF1; andon a third color component input, acquired second fluorescence imageAF2. AUGMENTED IMAGE CORRECTION process 232 again forms the average ofthe acquired visible color component images for generation of thelimited bandwidth visible image, but since only one visible colorcomponent image is acquired, the average is acquired first visible colorcomponent image AVC1. Each color component of the limited bandwidthimage, in this example, is acquired first visible color component imageAVC1.

AUGMENTED IMAGE CORRECTION process 232B, in this example, adds acquiredfirst fluorescence image AF1 to the second color component of thelimited bandwidth image, which is acquired first visible color componentimage AVC1, and provides the result to the output for the second visiblecolor component. AUGMENTED IMAGE CORRECTION process 232B also addsacquired second fluorescence image AF2 to the third color component ofthe limited bandwidth image, which to acquired first visible colorcomponent image AVC1, and provides the result to the output for thethird visible color component. In this implementation, any pixel whichcontains both pixel data from image AF1 and pixel data from image AF2takes on some intermediate color.

In this example, the acquired first visible color component image AVC1is sent to the first visible color component output. The acquired firstvisible color component image AVC1 plus the acquired first fluorescenceimage AF1 is sent to the second visible color component output. Theacquired first visible color component image AVC1 plus the acquiredsecond fluorescence image AF2 is sent to the third visible colorcomponent output.

The outputs from AUGMENTED IMAGE CORRECTION process 232 are displayed onstereoscopic display 241 (FIG. 2) in GENERATE STEREOSCOPIC VIDEO DISPLAYOF TISSUE process 305 (FIG. 3). In the augmented viewing mode, processes301 to 305 are performed repetitively so that the surgeon sees areal-time video augmented image of tissue 203.

Thus, during the augmented viewing mode, the surgeon is provided with athree-dimensional limited-bandwidth image of tissue 203 with a firstregion of interest highlighted in a particular color and a second regionof interest highlighted in a different color.

Again, the processing for the augmented display does not introduce anylatency and does not require storage of a frame for subsequentprocessing with a later frame. The processing occurs in real time and sothe highlighted portions of the image are always synchronized with thelimited-bandwidth monochromatic portion of the image.

When the surgeon wants to change the viewing mode back to the normalstereoscopic color image at time t4 (FIG. 7), the surgeon uses displaymode select 250 (FIG. 2) to change the viewing mode to the normalviewing mode. In response to the change, the two fluorescence excitationillumination components in fluorescence excitation source 212 are turnedoff, the second and third visible color component illuminationcomponents are turned on and the first visible color illuminationcomponent is returned to the full output level. See FIG. 7. Theprocessing is the same as that described above for the normal viewingmode and so is not repeated.

In the above description, the camera was mounted proximal to theendoscope. However, this is illustrative only and is not intended to belimiting. The process works the same irrespective of the relativelocations of the viewing optics and the camera so long as the camera canacquire usable images from the light from the optics. For example, theprocesses and structures described herein can be utilized with achip-on-stick endoscope. A chip-on-stick endoscope has a short opticssegment with a camera located just behind the optics near the tip of theendoscope.

Also, a stereoscopic endoscope was used as an example. This also isillustrative only and is not intended to be limiting. A monoscopicendoscope could be used in place of the stereoscopic endoscope in theabove examples. With the monoscopic endoscope only one of the left andright images would be acquired and processed as described above.

The above description and the accompanying drawings that illustrateaspects and embodiments of the present inventions should not be taken aslimiting—the claims define the protected inventions. Various mechanical,compositional, structural, electrical, and operational changes may bemade without departing from the spirit and scope of this description andthe claims. In some instances, well-known circuits, structures, andtechniques have not been shown or described in detail to avoid obscuringthe invention.

Further, this description's terminology is not intended to limit theinvention. For example, spatially relative terms—such as “beneath”,“below”, “lower”, “above”, “upper”, “proximal”, “distal”, and thelike—may be used to describe one element's or feature's relationship toanother element or feature as illustrated in the figures. Thesespatially relative terms are intended to encompass different positions(i.e., locations) and orientations (i.e., rotational placements) of thedevice in use or operation in addition to the position and orientationshown in the figures. For example, if the device in the figures isturned over, elements described as “below” or “beneath” other elementsor features would then be “above” or “over” the other elements orfeatures. Thus, the exemplary term “below” can encompass both positionsand orientations of above and below. The device may be otherwiseoriented (rotated 90 degrees or at other orientations) and the spatiallyrelative descriptors used herein interpreted accordingly. Likewise,descriptions of movement along and around various axes include variousspecial device positions and orientations.

The singular forms “a”, “an”, and “the” are intended to include theplural forms as well, unless the context indicates otherwise. The terms“comprises”, “comprising”, “includes”, and the like specify the presenceof stated features, steps, operations, elements, and/or components butdo not preclude the presence or addition of one or more other features,steps, operations, elements, components, and/or groups. Componentsdescribed as coupled may be electrically or mechanically directlycoupled, or they may be indirectly coupled via one or more intermediatecomponents.

Memory refers to a volatile memory, a non-volatile memory, or anycombination of the two. A processor is coupled to a memory containinginstructions executed by the processor. This could be accomplishedwithin a computer system, or alternatively via a connection to anothercomputer via modems and analog lines, or digital interfaces and adigital carrier line.

Herein, a computer program product comprises a non-transitory mediumconfigured to store computer readable code needed for any one or anycombination of the operations described with respect to the augmenteddisplay system or in which computer readable code for any one or anycombination of operations described with respect to the augmenteddisplay system is stored. Some examples of computer program products areCD-ROM discs, DVD discs, flash memory, ROM cards, floppy discs, magnetictapes, computer hard drives, servers on a network and signalstransmitted over a network representing computer readable program code.A non-transitory tangible computer program product comprises anon-transitory tangible medium configured to store computer readableinstructions for any one of, or any combination of operations describedwith respect to the augmented display system or in which computerreadable instructions for any one of, or any combination of operationsdescribed with respect to the augmented display system are stored.Non-transitory tangible computer program products are CD-ROM discs, DVDdiscs, flash memory, ROM cards, floppy discs, magnetic tapes, computerhard drives and other non-transitory physical storage mediums.

In view of this disclosure, instructions used in any one of, or anycombination of operations described with respect to the augmenteddisplay system can be implemented in a wide variety of computer systemconfigurations using an operating system and computer programminglanguage of interest to the user.

All examples and illustrative references are non-limiting and should notbe used to limit the claims to specific implementations and embodimentsdescribed herein and their equivalents. The headings are solely forformatting and should not be used to limit the subject matter in anyway, because text under one heading may cross reference or apply to textunder one or more headings. Finally, in view of this disclosure,particular features described in relation to one aspect or embodimentmay be applied to other disclosed aspects or embodiments of theinvention, even though not specifically shown in the drawings ordescribed in the text.

1. A surgical system comprising: (i) a camera, the camera being configured to capture a first acquired component image and to capture a second acquired component image different from the first acquired component image; (ii) a controller connected to the camera, the controller being configured to generate a first visible color component output, the first visible color component output being the first acquired component image, and the first visible color component being a first visible color component of a plurality of color components of white light; the controller being configured to generate a second visible color component output, the second visible color component output including the first acquired component image; the controller being configured to include the second acquired component image in the second visible color component output so that the second visible color component output is a combination of both the first acquired component image and the second acquired component image, the second visible color component being a second visible color component of the plurality of color components of white light, and the second acquired component image comprising a fluorescence image excited by a fluorescence excitation illumination component; and the controller being configured to generate a third visible color component output, the third visible color component output being the first acquired component image, the third visible color component being a third visible color component of the plurality of color components of white light; (iii) a display connected to the controller, the display being configured to receive the first, second, and third visible color component outputs, the display being configured to display the first, second and third visible color component outputs to obtain a monochromatic image combined with the second acquired component image, and the second acquired component image being highlighted relative to the monochromatic image.
 2. The system of claim 1, further comprising: an illuminator, the illuminator being configured to provide simultaneously at least two illumination components, wherein when one of the illumination components comprises the fluorescence excitation illumination component, and wherein other illumination components include less than all the plurality of visible color illumination components of white light illumination.
 3. The system of claim 2, the other illumination components including a first visible color illumination component; and the first acquired component image comprising an acquired first visible color component image.
 4. The system of claim 2, the other illumination components including a first visible color illumination component and a second visible color illumination component.
 5. The system of claim 4, the camera further being configured to capture a third acquired component image, the first acquired component image being an acquired first visible color component image; the second acquired component image being an acquired fluorescence image; and the third acquired component image being an acquired second visible color component image.
 6. The system of claim 5, the controller being configured to generate the first and third visible color component outputs from the acquired first and second visible color component images; and the controller being configured to generate the second visible color component output from the acquired first and second visible color component images and the acquired fluorescence image.
 7. The system of claim 6, the first visible color component output being a blue color component output, and the second visible color component output being a green color component output.
 8. The system of claim 6, the second visible color component output being a green color component output.
 9. The system of claim 2, the other illumination components comprising a first visible illumination component and a second fluorescence excitation illumination component.
 10. The system of claim 9, the camera further being configured to capture a third acquired component image, the first acquired component being an acquired first visible color component image; the second acquired component image being an acquired first fluorescence image; and the third acquired component image being an acquired second fluorescence image.
 11. The system of claim 10, the controller being configured to add the third acquired component image to the third visible color component output.
 12. The system of claim 2, the illuminator including: a first visible color illumination component source; a second visible color illumination component source, the second visible color illumination component being different from the first visible color illumination component; a third visible color illumination component source, the third visible color illumination component being different from the second visible color illumination component, and different from the first visible color illumination component; and a fluorescence excitation illumination source; and the system further comprising: a power level and power supply controller connected to the first, second, and third visible color component illumination sources, and to the fluorescence excitation illumination source; and a mode changer coupled to the power level and power supply controller, the mode changer having a first state and a second state, when the mode changer has the first state, the power level and power supply controller (a) being configured to provide power to the first, second, and third visible color illumination component sources, and not to the fluorescence excitation illumination source, and (b) the first, second, and third visible color illumination component sources each having a first level of illumination; and when the mode changer has the second state, the power level and power supply controller (a) being configured to provide power to the first visible color illumination component source, to at least a portion of the second visible color illumination component source and to the fluorescence excitation illumination source, and not to the third visible color illumination component source, and (b) being configured to reduce the levels of illumination of the first visible color illumination component source and the second visible color illumination component source. 13-22. (canceled) 